MEDICARE: MRS. SHERRY MOUA APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	822957	TX

General Provider Information

NPI Number	:	1649756305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRY MOUA APRN, FNP-C

Provider Business Mailing Address
First Line	:	4140 HERITAGE TRACE PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5310
Country	:	US
Telephone Number	:	817-741-7501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4140 HERITAGE TRACE PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5310
Country	:	US
Telephone Number	:	817-741-7353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	11/06/2019

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